Predictors of Progression in IgA Nephropathy in Childhood

Abstract

The aim of this retrospective study was to assess the usefulness of potential predictors of poor prognosis in IgA nephropathy in children. The study population consisted of 55 children aged 11 ± 4 years, diagnosed on the basis of the Oxford classification and MEST score of kidney biopsy findings. Proteinuria, glomerular filtration rate (GFR), and the IgA/C3 serum ratio were assessed in all patients twice: at onset and at follow-up. The patients were treated with steroids, immunosuppressive drugs, and/or angiotensin-converting enzyme inhibitors. Follow-up was at 3.9 ± 2.9 (median 2.7) years. The patients were subdivided into two groups: with GFR <90 and ≥90 mL/min at follow-up. ROC AUC curves and logistic regression were used to evaluate the power of prognostic factors. The two groups did not differ regarding the level of proteinuria, MEST score, and the IgA/C3 ratio at onset of disease. There was a significant association between GFR reductions at onset and follow-up (AUC = 0.660; p < 0.05). In patients with nephrotic range proteinuria at onset, proteinuria at follow-up was more frequent compared with other patients (AUC = 0.760; p < 0.05), MEST score ≥3 tended to be associated with reduced GFR (AUC = 0.650; p = 0.07) but not with proteinuria (AUC = 0.608; p = 0.47), and the IgA/C3 ratio was higher (p < 0.05) at follow-up. No significant associations were found between the IgA/C3 ratio at onset and reduced GFR (AUC = 0.565; p = 0.46) or proteinuria at follow-up (AUC = 0.263; p = 0.20). We conclude that predictors of poor outcome in childhood IgAN include the following: GFR reduction, nephrotic range proteinuria at onset of disease, and high MEST score in Oxford classification of kidney biopsy. Despite a higher serum IgA/C3 ratio in children with impaired renal function in long-term follow-up, we failed to demonstrate a significant association between this ratio at onset of disease and reduced GFR or persistent proteinuria at follow-up. Thus, IgA/C3 ratio is not a good foreteller of progression of IgA nephropathy in childhood.

Remission of Proteinuria May Protect against Progression to Chronic Kidney Disease in Pediatric-Onset IgA Nephropathy

“…Both CHP as a presenting symptom and eGFR < 60 mL/min/1.73 m 2 at renal biopsy were found to be significant factors that were associated with progression to CKD. Our finding that decreased renal function at diagnosis is associated with poor outcome in patients diagnosed with IgAN is consistent with the results of previous studies [26,31]. CHP has also been identified as a risk factor for CKD progression in the general population [32,33].…”

Clinical importance of the updated Oxford classification in allograft IgA nephropathy

“…Many studies have been performed to predict the outcomes for patients with native IgAN owing to the heterogeneous prognosis of the disease . In addition to well‐studied clinical variables, such as baseline renal function, proteinuria, and high blood pressure, pathologic parameters are important prognostic markers for IgAN .…”

Serum IgA/C3 ratio and glomerular C3 staining predict progression of IgA nephropathy in children

“…Clinically, therapy for IgAN depends mostly on risk factors (proteinuria, GFR, and the histopathological findings in renal biopsy) (18). Predictors of poor outcomes in childhood IgAN include proteinuria at the onset of disease.…”